HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L - j;i
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
III �illml!lllll Pill IIIIIIIII
Property Tax ID #: �i'�OZ- '103' 0003 " DOO ` Z Lot No.
Site Plan Name:
Project Name:�aM �111fGi�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
4c2, 2 t,J:t\&OutS -fi tt doors -ro �m
CONSTRUCTION INFORMATION:
�HVAC U Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
Block No.
perrna—cnecxau n appry:
Gas Piping Shutters Windows/Doors
Sprinklers Generator Roof
S Ft. of First Floor: _
Utilities: .Sewer Septic
Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
Name LDi
S to rs/%�
Name:
MAP r -C
Address:
OA50S.oczan Dr. 202
Company: �i1SY)LOr.J
`r Door OP iGr� tn�r"
City: Tg�n %Meac-A. State:,M
Zip Code: 4qS% Fax:
Phone No. IIdL ��g `^ 135�
Address: 13[01 7 Wte,r QgrlL Ur:
City: IiIt�
Zip Code: 33Ls&
Phone No. 5(01` 'N
State: FL
Fax: 5�p1—%Ny 253
TS ` 4805
E-Mail: +O.bU�f1Li% 367 O7) MCI , r OM
Fill in fee
from the
simple Title Holder on next page ( if different
Owner listed above)
E-Mail: PPiYYrti'YC &
as AM com
State or County License:
Stems 13t�2�y313�22y3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_
MORTGAGE COMPANY: / Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: ✓Not Applicable
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CountyI
conniakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in flict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement m result in your paying twice for
improvements to our property. A Notice of Commencement must be rec ed and posted on the jobsite
before the first in pgction. If you intend to obtain financing4consult with I der or an attorney before
as Agent for Owner
COUNTY OF
The forgoing instrument was acknowledged before me
thisQthlayof NiNeMbex zo4.oby
The forgoing instrument was acknowledged before me
thisgri` day of N OVBMb2t , 20 Zb by
�abOf'FSuMt�K ��5�� S.�mme.rS
(Name of person acknowledging) - (Name of person acknowledging )
(Signature of Notary Public -State of Florida ) (Signature of Notary Public- State of Florida )
Personally Known � OR Produced Identification Personally Known ✓ZOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
Revised 07/15/20
(Seal)
Commission No.
(Seal)
REVIEWS
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REVIEW
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PLANS
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VEGETATION
REVIEW
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SEA TURTLE
REVIEW
DATE
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INITIALS